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Observational Study
. 2023 Aug 1;40(8):578-586.
doi: 10.1097/EJA.0000000000001863. Epub 2023 Jun 1.

A comprehensive echocardiographic analysis during simulated hypovolaemia: An observational study

Aarne Feldheiser  1 , Peter Juhl-Olsen, Michael Nordine, Matthias Stetzuhn, Ludwig Wiegank, Fabian Knebel, Sascha Treskatsch, Christian Berger
Affiliations
Observational Study

A comprehensive echocardiographic analysis during simulated hypovolaemia: An observational study

Aarne Feldheiser et al. Eur J Anaesthesiol. .

Abstract

Background: Peri-operative and critically ill patients often experience mild to moderate hypovolaemic shock with preserved mean arterial pressure (MAP), heart rate (HR) and decreased stroke volume index (SVI).

Objectives: The aim of this study was to evaluate echocardiographic parameters during simulated mild to moderate central hypovolaemia.

Design: This was a prospective preclinical study.

Setting: Laboratory trial performed in Charité-Universitätsmedizin Berlin, Germany.

Patients and methods: Thirty healthy male volunteers underwent graded central hypovolaemia using a lower body negative pressure (LBNP) chamber with a stepwise decrease to simulate a mild (-15 mmHg), mild-to-moderate (-30 mmHg), and moderate state of hypovolaemic shock (-45 mmHg). During every stage, a transthoracic echocardiography examination (TTE) was performed by a certified examiner.

Main outcome measures: Systolic and diastolic myocardial performance markers, as well as cardiac volumes were recorded during simulated hypovolaemia and compared to baseline values.

Results: During simulated hypovolaemia via LBNP, SVI decreased progressively at all stages, whereas MAP and HR did not consistently change. Left ventricular (LV) ejection fraction decreased at -30 and -45 mmHg. Simultaneously with SVI decline, LV global longitudinal strain (LV GLS), tricuspid annular plain systolic excursion (TAPSE), and right ventricular RV S' and left-atrial end-systolic volume (LA ESV) decreased compared to baseline at all stages.

Conclusions: In this study, simulated central hypovolaemia using LBNP did not induce consistent changes in MAP and HR. SVI decreased and was associated with deteriorated right- and left-ventricular function, observed with echocardiography. The decreased filling status was characterised by decreased LA ESV.

Clinical trial number: ClinicalTrials.gov Identifier: NCT03481855.

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